Scarf osteotomy without internal fixation to correct hallux valgus

Abstract

Scarf osteotomy of the first metatarsal bone to correct hallux valgus deformity has benefited from a number of improvements over the past two decades, most notably regarding the internal fixation method. Internal fixation was deemed mandatory by the authors of early case-series studies. Maestro suggested eliminating the proximal screw by locking the two fragments distally: a notch was created via a medial extension of the cephalic part of the osteotomy, the plantar fragment was displaced laterally, and the distal end of the proximal fragment was then fit into the notch (secondary cut and interlocking joint technique). To further develop this concept and to increase the potential range of translation, we developed an original technique involving distal locking without shortening and proximal stabilisation by impaction of a cortical-cancellous bone graft taken from the medial overhanging edge of the proximal fragment. This original technical variant has not been reported previously.